Assessment of Older People's Health and Social Care Needs and ...

Standard AssessmentThe standard psychiatric assessment is carried out by one of the medical members of the multidisciplinaryteam, with further assessment by other members of the team as required. This mightinclude input from some or all of nursing, psychology, social work and occupational therapy membersof the team. The emphasis is on domiciliary assessment because it gives a more accurateassessment of the individual's cognitive function, an opportunity to assess the home circumstancesand time to interview the carer. Collateral history is gathered from relevant sources, including thecarer, the family, the GP, ward staff if applicable, and home help.A history is taken from the patient in an individual interview. There we look at the patient'sperception of the problem, its history, duration, mode of onset and precipitating factors. We look atpast psychiatric history, relevant medical history, medication and alcohol use. The patient's socialsituation and supports are explored, as is his or her personal history.A mental state examination is conducted. This is a standard assessment used with younger peoplealso. With older people we assess particular areas, including appearance, behaviour, speech,hearing/sight loss, mood, thought (for example, the presence or absence of delusions) andperception (e.g. visual or auditory hallucinations).For cognitive assessment, various tools can be used. One of the most common is the Mini MentalState Examination. This looks at orientation, language, memory and praxia. In addition, a tool forassessing dependency such as the CAPE can be a useful adjunct to the assessment.FormulationHaving completed the assessment, we come to the formulation. This incorporates a diagnosis, a viewof the severity of the condition and its prognosis. We look at precipitating or perpetuating factors,relevant medical factors, social supports and the level of functioning of the individual in thecommunity or nursing home and how the individual might be helped in these areas. Medicalinvestigations can be done if needed, for example, physical examination, dementia screening,urinalysis, ECG, CXR or CT scan. The management plan is then put together.Management PlanIn developing a management plan for the individual, we look at the following:• supports that are available, in terms of the individual's social supports, day care and the supportthat members of the multi-disciplinary team, such as the psychologist or community psychiatricnurse can offer to patients in the community• liaison with local statutory or voluntary agencies that might be necessary or beneficial• the treatments that might be sUitable, for example, medication or Electra-Convulsive Therapy, orpsychological treatment such as Cognitive Behavioural Therapy• advice/education that can be given• day hospital admission• or full time hospital admission, if necessary.Assessment of Older ~e~ple's Health and Social Care Needs ar1d_Prefe~~~e~ __